Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States
Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control COVID-19 in the US have not accounted for heterogeneity in social or environmental factors that may influence NPI effectiveness. This study quantifies national and sub-national effect sizes of NPIs dur...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:7af59acd783b4d929290096bc69395b62021-12-01T13:00:51ZHeterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States2296-256510.3389/fpubh.2021.754696https://doaj.org/article/7af59acd783b4d929290096bc69395b62021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpubh.2021.754696/fullhttps://doaj.org/toc/2296-2565Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control COVID-19 in the US have not accounted for heterogeneity in social or environmental factors that may influence NPI effectiveness. This study quantifies national and sub-national effect sizes of NPIs during the early months of the pandemic in the US.Methods: Daily county-level COVID-19 cases and deaths during the first wave (January 2020 through phased removal of interventions) were obtained. County-level cases, doubling times, and death rates were compared to four increasingly restrictive NPI levels. Socio-demographic, climate and mobility factors were analyzed to explain and evaluate NPI heterogeneity, with mobility used to approximate NPI compliance. Analyses were conducted separately for the US and for each Census regions (Pacific, Mountain, east/West North Central, East/West South Central, South Atlantic, Middle Atlantic and New England). A stepped-wedge cluster-randomized trial analysis was used, leveraging the phased implementation of policies.Results: Aggressive (level 4) NPIs were associated with slower COVID-19 propagation, particularly in high compliance counties. Longer duration of level 4 NPIs was associated with lower case rates (log beta −0.028, 95% CI −0.04 to −0.02) and longer doubling times (log beta 0.02, 95% CI 0.01–0.03). Effects varied by Census region, for example, level 4 effects on doubling time in Pacific states were opposite to those in Middle Atlantic and New England states. NPI heterogeneity can be explained by differential timing of policy initiation and by variable socio-demographic county characteristics that predict compliance, particularly poverty and racial/ethnic population. Climate exhibits relatively consistent relationships across Census regions, for example, higher minimum temperature and specific humidity were associated with lower doubling times and higher death rates for this period of analysis in South Central, South Atlantic, Middle Atlantic, and New England states.Conclusion and Relevance: Heterogeneity exists in both the effectiveness of NPIs across US Census regions and policy compliance. This county-level variability indicates that control strategies are best designed at community-levels where policies can be tuned based on knowledge of local disparities and compliance with public health ordinances.William K. PanWilliam K. PanDaniel FernándezDaniel FernándezStefanos TyrovolasStefanos TyrovolasStefanos TyrovolasGiné-Vázquez IagoGiné-Vázquez IagoRishav Raj DasguptaBenjamin F. ZaitchikPaul M. LantosPaul M. LantosChristopher W. WoodsChristopher W. WoodsFrontiers Media S.A.articleSARS-CoV-2non-pharmaceutical intervention (NPI)doubling timemortality rateUnited StatesPublic aspects of medicineRA1-1270ENFrontiers in Public Health, Vol 9 (2021) |
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SARS-CoV-2 non-pharmaceutical intervention (NPI) doubling time mortality rate United States Public aspects of medicine RA1-1270 |
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SARS-CoV-2 non-pharmaceutical intervention (NPI) doubling time mortality rate United States Public aspects of medicine RA1-1270 William K. Pan William K. Pan Daniel Fernández Daniel Fernández Stefanos Tyrovolas Stefanos Tyrovolas Stefanos Tyrovolas Giné-Vázquez Iago Giné-Vázquez Iago Rishav Raj Dasgupta Benjamin F. Zaitchik Paul M. Lantos Paul M. Lantos Christopher W. Woods Christopher W. Woods Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States |
| description |
Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control COVID-19 in the US have not accounted for heterogeneity in social or environmental factors that may influence NPI effectiveness. This study quantifies national and sub-national effect sizes of NPIs during the early months of the pandemic in the US.Methods: Daily county-level COVID-19 cases and deaths during the first wave (January 2020 through phased removal of interventions) were obtained. County-level cases, doubling times, and death rates were compared to four increasingly restrictive NPI levels. Socio-demographic, climate and mobility factors were analyzed to explain and evaluate NPI heterogeneity, with mobility used to approximate NPI compliance. Analyses were conducted separately for the US and for each Census regions (Pacific, Mountain, east/West North Central, East/West South Central, South Atlantic, Middle Atlantic and New England). A stepped-wedge cluster-randomized trial analysis was used, leveraging the phased implementation of policies.Results: Aggressive (level 4) NPIs were associated with slower COVID-19 propagation, particularly in high compliance counties. Longer duration of level 4 NPIs was associated with lower case rates (log beta −0.028, 95% CI −0.04 to −0.02) and longer doubling times (log beta 0.02, 95% CI 0.01–0.03). Effects varied by Census region, for example, level 4 effects on doubling time in Pacific states were opposite to those in Middle Atlantic and New England states. NPI heterogeneity can be explained by differential timing of policy initiation and by variable socio-demographic county characteristics that predict compliance, particularly poverty and racial/ethnic population. Climate exhibits relatively consistent relationships across Census regions, for example, higher minimum temperature and specific humidity were associated with lower doubling times and higher death rates for this period of analysis in South Central, South Atlantic, Middle Atlantic, and New England states.Conclusion and Relevance: Heterogeneity exists in both the effectiveness of NPIs across US Census regions and policy compliance. This county-level variability indicates that control strategies are best designed at community-levels where policies can be tuned based on knowledge of local disparities and compliance with public health ordinances. |
| format |
article |
| author |
William K. Pan William K. Pan Daniel Fernández Daniel Fernández Stefanos Tyrovolas Stefanos Tyrovolas Stefanos Tyrovolas Giné-Vázquez Iago Giné-Vázquez Iago Rishav Raj Dasgupta Benjamin F. Zaitchik Paul M. Lantos Paul M. Lantos Christopher W. Woods Christopher W. Woods |
| author_facet |
William K. Pan William K. Pan Daniel Fernández Daniel Fernández Stefanos Tyrovolas Stefanos Tyrovolas Stefanos Tyrovolas Giné-Vázquez Iago Giné-Vázquez Iago Rishav Raj Dasgupta Benjamin F. Zaitchik Paul M. Lantos Paul M. Lantos Christopher W. Woods Christopher W. Woods |
| author_sort |
William K. Pan |
| title |
Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States |
| title_short |
Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States |
| title_full |
Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States |
| title_fullStr |
Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States |
| title_full_unstemmed |
Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States |
| title_sort |
heterogeneity in the effectiveness of non-pharmaceutical interventions during the first sars-cov2 wave in the united states |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/7af59acd783b4d929290096bc69395b6 |
| work_keys_str_mv |
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